Annals for Educators - July 2022
Authors: Christine Laine
Journal: Annals of Internal Medicine (2022)

Web ExclusivesJuly 2022Annals for Educators - July 2022FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202207190 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsAssociation of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee Consumption With All-Cause and Cause-Specific Mortality. A Large Prospective Cohort StudyThe Potential Health Benefit of Coffee: Does a Spoonful of Sugar Make It All Go Away?Coffee is one of the most commonly consumed beverages in the world, and there has been long-standing interest in its health effects. This observational study examined the relationship between consumption of sugar-sweetened, artificially sweetened, and unsweetened coffee and all-cause and cause-specific mortality. The accompanying editorial discusses the findings and the questions this study leaves unanswered.Use this article and the editorial to:Review how observational and interventional studies differ and why this study cannot prove that coffee is causally related to longevity.Ask your learners if there are potential confounders in addition to the factors this study accounted for that might influence the association of increased coffee intake and longevity.Discuss other health benefits that have been associated with increased coffee intake.If there was a true causal effect of coffee intake on longevity, what could be potential mechanisms?Human Papillomavirus Vaccine Impact and Effectiveness Through 12 Years After Vaccine Introduction in the United States, 2003 to 2018Long-Term Effectiveness of Human Papillomavirus Vaccination: Implications for Future Reduction in CancerThis study used the most recent NHANES data to estimate the impact of the human papillomavirus (HPV) vaccination program on vaccinated and unvaccinated sexually experienced females and also estimated the effectiveness in HPV prevalence for males and females for the most recent periods with data available. The accompanying editorial discusses the findings and actions that will be crucial to ensuring we do not lose a generation to preventable HPV-associated cancer.Use this article and the editorial to:Review the recommendations for HPV vaccination. This article provides the most recent U.S. recommendations. Discuss why vaccination helps to reduce HPV-associated cancer in both vaccinated and unvaccinated persons.Ask your learners if they routinely consider HPV vaccination when evaluating whether there are vaccines that are beneficial to their patients.Invite a pharmacist to your session to discuss what should be done if patients received only partial vaccination. Is it necessary to repeat vaccination from the first dose?U.S. Trends in Registration for Medical Cannabis and Reasons for Use From 2016 to 2020. An Observational StudyMany states have enacted laws that increase the availability of medical and recreational products made from cannabis. This article examines use of medical cannabis and focuses on changes from 2016 to 2020 in the number of people registered to use it and the types of conditions used to justify it.Use this article to:Review the cannabis laws in the states in which your learners care for patients.If medical cannabis is available in your state, review where your learners could refer patients for treatment.Ask your learners if they have patients who use cannabis for medical purposes. What conditions do their patients use it for? Do patients report benefit?Review the evidence for the effectiveness and safety of cannabis as treatment for chronic pain. This systematic review and the accompanying brief video can help guide the discussion. Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery. A Randomized Clinical TrialSevere Pain After Hip Fracture Repair in Older Adults: Challenging a Dominant NarrativeThe REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial found similar ambulation and survival at 60 days with spinal versus general anesthesia for hip fracture surgery. This article reports outcomes evaluating pain over 365 days, prescription analgesic use, and patient satisfaction. The authors of the accompanying editorial applaud the researchers for studying important questions to help these patients and their caregivers.Use this article and the editorial to:Discuss general preoperative evaluation of patients undergoing surgery for hip fracture.Invite an anesthesiologist or orthopedic surgeon to discuss the types of anesthesia typically used during hip fracture surgery at your institution.Based on the findings of this study, how would your learners advise patients undergoing hip fracture surgery about the choice of anesthesia?Discuss the implications of these findings for postoperative management of patients after hip fracture surgery.A Longitudinal Study of COVID-19 Sequelae and Immunity: Baseline FindingsUnderstanding and Improving Recovery From COVID-19A substantial proportion of persons who develop COVID-19 experience postacute sequelae of SARS-CoV-2 infection (PASC). This article reports baseline findings from an ongoing longitudinal cohort study that seeks to characterize the risk factors, clinical findings, laboratory features, and natural history of PASC. The accompanying editorial discusses the need for research to help us understand this condition and the importance of not allowing objective testing to overshadow patient experience as we gain a better understanding of PASC.Use this article and the editorial to:Watch all or part of the 24 May 2022 Annals/ACP COVID-19 forum, which begins with Dr. Clifford Lane, one of the study authors, giving a summary of the study and its findings. Ask your learners if they have encountered patients reporting persisting symptoms after recovery from acute SARS-CoV-2 infection. What symptoms do patients report?Determine whether there is a “post-COVID” clinic site at your institution or in the surrounding area, and invite a clinician to discuss the approach they use when caring for patients with persisting symptoms after COVID-19.Present some typical cases (there are 3 in the forum mentioned above), and discuss best management given what we know about persisting symptoms after COVID-19.Effectiveness and Harms of Contraceptive Counseling and Provision Interventions for Women. A Systematic Review and Meta-analysisContraceptive Counseling: An Essential Component of Preventive Health CareDespite availability of effective contraception, many pregnancies are unintended. This systematic review examined the effectiveness and harms of contraceptive counseling and interventions for women and adolescents in various clinical settings to increase use of contraceptives and reduce unintended pregnancies. The accompanying editorial discusses the importance of easy, effective, accessible, and affordable contraception as ending unintended pregnancy becomes increasingly difficult.Use this article and the editorial to:Begin your session by watching the brief video that summarizes the systematic evidence review. Ask your learners whether they routinely counsel their patients who are of childbearing potential about contraception. If not, why not?Discuss common options for female and male contraception. Ask your learners which of these are currently feasible to prescribe or administer in the settings where your learners see patients. What changes would need to be made to increase feasibility?Review the current legal status of abortion in your state. Discuss with your learners what they would and could legally do if a patient presented to them inquiring about termination of an unintended pregnancy.ProfessionalismRethinking Professionalism Assessments in Medical EducationProfessionalism has been part of medical education for decades, but a consensus definition of it does not exist. This article describes some of the harms that result and proposes ways to prevent them.Use this article to:Ask your learners to work as a group to come up with their own definition of professionalism in medicine.Review how your program evaluates trainees' professionalism.Discuss whether there are potential harms of the current methods for evaluating professionalism. How might assessments of professionalism be improved?Bipolar DisorderBipolar disorder affects approximately 2% of U.S. adults and is the most expensive mental health condition for commercial insurers nationwide. Rates of bipolar disorder are elevated among persons with depression, anxiety disorders, and substance use disorders—conditions frequently seen by primary care clinicians. In addition, antidepressants can precipitate manic or hypomanic symptoms or rapid cycling in persons with undiagnosed bipolar disorder. Thus, screening for bipolar disorder in these high-risk groups is indicated. Effective treatments exist for hypomania and mania, bipolar depression, and maintenance. Many such treatments can be safely and effectively administered by primary care clinicians.Use this article to:Review the diagnostic criteria for bipolar depression.Review the first-line therapy for bipolar depression.Discuss the implications of bipolar depression in patients with common chronic medical conditions, such as diabetes, hypertension, substance use disorder, HIV infection, and cardiovascular disease.Discuss whether your learners think that internal medicine physicians can and should manage bipolar depression or if all patients with this condition should be referred to psychiatrists.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics July 2022Volume 175, Issue 7Page: ED7 ePublished: 19 July 2022 Issue Published: July 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...